Overview of Arthritis – The Basics
- Arthritis is a degenerative condition due to wear & tear of the articular surfaces of joint
- It can be caused by mechanical process (Osteoarthritis) or inflammatory process (Rheumatoid arthritis, etc.)
- Once the wear & tear process starts, it continues to progress in spite of treatment
- The end result is a painful joint with stiffness, deformity and functional impairment
- Impact of arthritis:
- Pain
- Limitation of activities
- Loss of independence
- Poor health and other hazards
- Loss of productivity and job loss
- Cost of care
- Psycho-social problems
What is Arthritis ?
Arthritis is a degenerative condition that occurs due to wear & tear of the articular surfaces of joints. It can be caused by degenerative process (osteoarthritis), inflammatory process (rheumatiod arthritis, ankylosing spondylarthropathy, connective tissue diseases, etc.) or incongruity of joint surfaces (post-traumatic arthritis, avascular necrosis, developmental dysplasia, etc.).
What are the types of arthritis?
Osteoarthritis: This type of arthritis results from mechanical wear and tear of the joint. This is commonly due age-related wear and tear (degenerative arthritis). This can also be caused by incongruity of joint surfaces secondary to injury (post-traumatic arthritis), loss of bony support (avascular necrosis) or congenital deformities (dysplasia).
Inflammatory arthritis: This type of arthritis is caused by inflammation of the joints. In this disease, the immune system of the body reacts against the joints and musculoskeletal tissues. This causes inflammation of joints, and leads to wear and tear.
The commonest type of inflammatory arthritis is rheumatoid arthritis.Less common types are ankylosing spondylarthropathy, Lyme disease, gouty arthritis and those associated with connective tissue disease, psoriasis, inflammatory bowel disease, etc.
Other types of arthritis: Infection of the joint also causes arthritis. This can be bacterial (septic arthritis), tubercular or fungal infection. The presentation of this type of arthritis is usually acute and is different from the other types of arthritis. It needs immediate washout of the joint along with appropriate anti-microbial medications. Rapid destruction of the joint occurs if treatment is delayed. If the joint surfaces are damaged or destroyed, it leads to progressive wear and tear similar to the other types of arthritis.
Can you cure arthritis?
No – you can only control it. The wear & tear process of arthritis is progressive. Once established, it cannot be reversed or halted. However, it can be slowed down by modification of activities, weight-reduction, medications (in case of inflammatory arthritis) and correction of deformities (like bow-leg deformity). However it cannot be completely stopped and the joint continues to wear out in spite of treatment.
What happens to the joint in advanced arthritis?
When a large portion of cartilage is worn away it leads to more pain, further reduction of movements and onset of deformities. There is loss of the natural flexibility of the ligaments and capsule giving rise to contractures. The muscles that span across the joint become thin and weak and less flexible. In late stages there is erosion of the bone ends which can become quite severe. In inflammatory arthritis there is significant thinning of the bone as well. The end result is a worn out and painful joint with loss of movements and deformity resulting in functional impairment.
What is the impact of arthritis on the patient and family?
Advanced arthritis imposes serious physical, economic, mental and social burden on the patient and his family. In the elderly patients, this leads to chronic pain, difficulties in day-to-day activities, loss of independence and poor health due to immobility and lack of exercise. Young patients with arthritis face the possibility of social isolation, job loss, marital discord and a severely restricted lifestyle.
Physical burden:
Pain: Severe arthritis gives rise to increasing amount of pain. Initially the pain is present during activity but in later stages the patient gets pain at rest as well. In the most severe cases the patient gets pain during sleep (night cries) that severely affects the quality of life.
Limitation of activities: Pain and stiffness interfere with the patient’s mobility which leads to increasing physical limitations. Initially sporting and recreational activities get affected. Later on occupational activities become difficult. In severe cases even day-to-day tasks become problematic (activities of daily living).
Loss of independence: This is especially difficult for the elderly patients who live alone.
Poor health – and other hazards:
- As a result of limited mobility the general health of patient suffers. Lack of exercise and physical exertion causes weight gain, poor control of diabetes, poor cardiopulmonary fitness, etc.
- Pain and deformity result in limping. Limping worsens backache and can exacerbate the symptoms of spondylosis. Arthritis of the hip, in particular, can cause severe mal-alignment of the spine and directly lead to spondylosis. This is especially true with developmental disorders (hip dysplasia).
- Patients with arthritis are prone to falling and sustaining injuries. Hip fractures in the elderly are very common and almost always need surgical treatment.
- Prolonged use of painkillers can have side-effects on the kidneys (renal impairment) and heart (ischemic heart disease) and cardio-vascular system (sodium retention, hypertension).
- Anti-rheumatic medications (DMARDs) cause liver abnormalities, bone marrow depression and immune suppression. If only a single joint is severely affected, rheumatologists recommend treating that joint surgically rather than punish the whole body with DMARDs. In long-standing cases of inflammatory arthritis, the disease becomes burnt out (inactive). These patients have painful joints secondary to the destruction caused by arthritis. In these patients DMARDs do not give any relief. These patients actually benefit from joint replacement.
- Adverse effects of steroids: Sometimes steroids are given to control the inflammatory process. Steroids can cause hypertension, diabetes, osteoporosis, muscular weakness and depressed immunity.
Economic burden:
Patients who are affected by severe arthritis face difficulty in their job especially if it involves physical exertion or prolonged standing or travelling. Frequent leaves also result in loss of earnings and hampers career prospects. Some patients may need a full-time care-giver or nurse.
Psycho-social burden:
Pain and limited mobility prevent the patient from participating in an active social life. This leads to isolation from family and friends and inability to take part in social events. In severe cases they need a full-time care-giver which adds to the social burden. Young patients with arthritis face the possibility of social isolation, job loss, marital discord and inability to fulfill familial obligations like taking care of children, elders etc. All of the above contribute to a negative mental outlook and depression.
IN THE PRESS:
Arthritis in the young – my article in the Deccan Herald
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